A nurse is assessing a client who has fluid volume deficit. The nurse should expect which of the following findings?

Choice A: Bicarbonate excess is a sign of metabolic alkalosis, because this condition occurs when the body has too much bicarbonate or loses too much acid. This can happen in patients who have excessive vomiting, gastric suctioning, diuretic therapy, or antacid intake.

Choice B: Lethargy is a sign of metabolic alkalosis, because this condition affects the central nervous system and causes decreased level of consciousness, confusion, and drowsiness. Lethargy can also result from hypoxemia, which is a condition that occurs when the blood oxygen level is too low. This can happen in patients with metabolic alkalosis who have respiratory compensation and hypoventilation.

Choice C: Kussmaul's respirations are not a sign of metabolic alkalosis, but rather of metabolic acidosis. This is a condition that occurs when the body produces too much acid or loses too much bicarbonate. This can happen in patients who have diabetic ketoacidosis, renal failure, or lactic acidosis. Kussmaul's respirations are deep, rapid, and labored breathing that help to eliminate excess carbon dioxide and acid from the blood.

Choice D: Circumoral paresthesia is a sign of metabolic alkalosis, because this condition causes hypocalcemia, which is a condition that occurs when the blood calcium level is too low. This can happen in patients with metabolic alkalosis who have increased binding of calcium to albumin due to alkaline pH. Circumoral paresthesia is a tingling sensation around the mouth that indicates neuromuscular irritability.

Choice E: Flushing is not a sign of metabolic alkalosis, but rather of hypercalcemia, which is a condition that occurs when the blood calcium level is too high. This can happen in patients who have hyperparathyroidism, malignancy, or excessive calcium intake. Flushing is a reddening of the skin that indicates vasodilation and increased blood flow.

• Choice A Reason: This is correct because the client who has gastroenteritis and is febrile is likely to lose fluid through vomiting, diarrhea, and sweating. These losses can lead to dehydration, hypotension, and electrolyte imbalances. The nurse should monitor the client's vital signs, fluid intake and output, and weight, and administer fluids and electrolytes as ordered.
• Choice B Reason: This is incorrect because the client who has leftsided heart failure and has a BNP level of 600 pg/ml is likely to have fluid volume excess, not deficit. BNP is a hormone that is released by the heart when it is stretched by increased blood volume. A high BNP level indicates that the heart is failing to pump effectively and that fluid is accumulating in the lungs and other tissues. The nurse should monitor the client's respiratory status, oxygen saturation, edema, and weight, and administer diuretics and other medications as ordered.
• Choice C Reason: This is incorrect because the client who has endstage renal failure and is scheduled for dialysis today is likely to have fluid volume excess, not deficit. Renal failure impairs the kidney's ability to excrete fluid and waste products, leading to fluid retention and azotemia. Dialysis is a procedure that removes excess fluid and toxins from the blood using an artificial membrane. The nurse should monitor the client's blood pressure, fluid intake and output, weight, and laboratory values, and prepare the client for dialysis as ordered.
• Choice D Reason: This is incorrect because the client who has been NPO since midnight for endoscopy is unlikely to have a significant fluid volume deficit, unless they have other risk factors or comorbidities. NPO means nothing by mouth, which is a common instruction before certain procedures or surgeries to prevent aspiration. Endoscopy is a procedure that uses a flexible tube with a camera to examine the digestive tract. The nurse should verify the client's NPO status, check their consent form, and administer preoperative medications as ordered.